Outside Metro Manila, Bataan is among the provinces with rising cases of COVID-19. Before the Luzon-wide lockdown, it recorded only one confirmed case. As of April 24, there were 77 cases. More worrisome is the 55 COVID-19 cases among health workers of the Bataan General Hospital and Medical Center (BGHMC), a Department of Health-run facility.

Being a partner-province of the Zuellig Family Foundation, a virtual executive session for the governor and his health team was facilitated by ZFF to help analyze Bataan’s situation and recommend ways forward.

A resource person during this coaching was UP Response Team member Dr. Jomar Rabajante, who said that based on the trend in the province, interventions have been effective in slowing down the virus.

Some of these interventions are intensified information campaign using different platforms, contact tracing, free transportation services for health workers, training by the BGHMC of health personnel and inter-agency task force on infection control and prevention measures, scheduled public market operations, and heightened surveillance.

But Rabajante cautioned the province from being complacent. It should, according to Rabajante, intensify its detection, tracing, and testing capacities especially in the identified hotspot areas or those localities with high number of positive COVID-19 cases such as Balanga, Orani Orion, Samal, and Limay.

He highlighted the importance of preparing for worst case scenarios. He said that, if the ECQ is lifted after April 30, the peak of infection in the province may happen sometime in the first week of May. In that case, the province would require facilities and equipment beyond the present capacity of Bataan hospitals.

Given this probability, Bataan Governor Albert Garcia plans to develop a real-time monitoring system to get ahead of the problem, while adding, “We need health experts to guide us. I’d like to ask for hand-holding partnership to be ahead of the problem before it gets bigger.”

Public-private partnership for COVID-19 containment

To contain COVID-19 cases in BGHMC, the province signed a formal agreement with the DOH Central Luzon office/BGHMC, and the private hospital Centro Medico de Santisimo Rosario for the private hospital to treat emergency medical services after the closure of BGHMC’s out-patient department. The provincial government shoulders indigent residents’ expenses as BGHMC becomes exclusive to COVID-19 cases.

Aside from Centro Medico, patients needing elective surgeries, direct consultations, and other health needs not related to COVID-19 can go to the district hospitals.

ICTs for COVID-19 Response

As a step to mitigate the further spread of COVID-19, the province also intends to maximize all available information and communication technologies (ICTs). “This COVID-19 crisis made us realize so many things, and most of it are hard lessons. It made us realize the inefficiencies of our health system, fragmented layers of government, and even disoriented communication,” Garcia admitted.

ZFF Trustee Dr. Manuel Dayrit said everybody has to be on the same page so the LGU must do granular strategies in conducting risk assessments, which means, according to Dayrit, risk assessment must be done at different levels: individual, household, barangay, municipal, and provincial. Doing so would enable the LGU to make more precise plans and manage resources based on the priority needs of each level.

In response, Garcia shared their plan of setting up a call hub that will serve as a health command center. This command center will then be the central repository of all data related to COVID-19 cases within the jurisdiction of Bataan. It will enable faster detection and isolation of probable cases and consequently, speed up actions from the local health leadership.

Not just health response but employment as well

In addition, Bataan is also looking into the efficiency of texting mechanism to gather data from households and even hospitals. According to Garcia, texting might be a great platform since there are 170,000-180,000 cellphone users in Bataan. It can be an opportunity to reach many people about preventive measures and as a means to monitor the well-being of household members.

The LGU is also eyeing to maximize the presence of social media by setting up chatbots since majority of the population own social media accounts and it offers faster reply mechanisms. It will also give the people more options to send out their concerns given the limitations of short messaging service (SMS) or text.

This system will also provide employment as it requires manpower who will be responsible for collecting data from the callers and processing gathered data into comprehensible information. Likewise, data collected will enable the local chief executives to see if initiatives are flattening the curve and to plan their next actions. The executive session was held last April 21 is part of ZFF’s efforts to assist its partner provinces in responding to the threats of COVID-19.

Located at the southern tip of Bataan Province, Mariveles is home to the Freeport Area of Bataan (FAB). In 2018, it was the second richest municipality in the Philippines, according to a Commission on the Audit report. Job-seekers from other provinces flock to the area.

A fifth of Bataan’s population lives in Mariveles, making it the most populous of the province’s 11 municipalities and one city. Yet health services for its residents used to be limited to those provided by the rural health unit, barangay health stations, private clinics, and the Mariveles Mental Health Hospital. The nearest hospital was over an hour’s drive away in Balanga City.

Ria (name withheld upon request), a long-time Mariveles resident and whose husband works in a FAB locator, recalls how she had to fight for space in a packed bus to get to the Bataan General Hospital and Medical Center (BGHMC) in Balanga City, where she gave birth to her first-born in 2019. Each two-way trip that included tricycle rides would cost her almost P200, which for Ria was “too much, especially since we’re on a tight budget.”

White elephant to white knight

Governor Albert Garcia acknowledged the deficiency, saying in a February 2018 interview with ZFF, “There are RHUs (rural health units), lying-in clinics but no hospital so when an accident occurs, they still need to bring the victim to Balanga. Plus, the Freeport is there, the workers, the population, so it needs a functioning hospital,” then he added, “That is why by hook or by crook this year (2018), the hospital will open” referring to the then-unused hospital, which had its roots to the vision of the governor’s late father.

As a congressman in 2011, Enrique Garcia introduced a bill to build a Mariveles hospital, which led to remodeling and then a retrofitting in 2017 of an existing building that stood idle since, earning it the monicker Mariveles Display Hospital.

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But the Mariveles District Hospital (MDH) would finally open in September 2018. It rendered out-patient and emergency services. And once it opened, its progress was fast.

In August 2019, it was licensed to operate as an infirmary. In March 2020, it was upgraded to a licensed Level 1 hospital just two weeks after it was designated a COVID-19 referral hospital.

It has discharged the province’s youngest COVID-19 patient (3 years old) and the oldest couple (80 years old).

Tracing infected and looking after their welfare

Ria was among MDH’s COVID-19 patients. She was exposed to a friend who had the virus. She was immediately tracked, tested in the RHU, and picked by MDH personnel after results showed she was positive. At the MDH emergency room, hospital personnel explained the tests and treatment she would be undergoing. For Ria, everything happened quickly, efficiently.

Thanks to ZFF’s interventions, the provincial government had the proper protocols in place.

“Our added knowledge because of our partnership helped us to cope better with the pandemic,” Garcia said during the governors’ learning forum last June 30.

For Ria, the two-week hospital stay was made easier by the health workers.

“I gained another family there,” said Ria, who praised her doctors and nurses for their patience, courtesy, and genuine service. “You can feel they were there to serve and not merely work.”

From her first day until her discharge, Ria did not have to shell out money. “I had my medicines. I was fed on time. They gave me masks and soap for handwashing. Upon my discharge, I did not have to pay for anything. Plus, when I was discharged, they gave me a set of easy-to-understand tips to avoid COVID-19.”

Fortunately, too for Ria, she did not suffer any discrimination when she returned home. The same cannot be said of MDH health staff, who were not welcome in their neighborhoods. So the Mariveles government and community responded. The local government opened a dormitory for the staff. Community members gave them meals and comfort food like milk tea. A FAB locator manufactured face masks for the health front-liners.

Service delivery network

Thankfully, too, its health service delivery network (SDN) has finally improved. MDH chief Dr. Hector Santos, who also oversees the Orani District Hospital, said the functional SDN has made it easier to refer and track all patients and not just those with COVID-19.

Governor Garcia said likewise, “There is that highly elusive service delivery network during normal times when it was a challenge for all LGUs to cooperate toward an efficient SDN. Because there was a crisis, and with help from our partners, we were able to integrate this health system that is now addressing our COVID response.”

Bataan’s proximity to Metro Manila contributed to its numerous COVID-19 cases. Acting swiftly and decisively to the crisis, however, has kept the pandemic manageable.

Coronavirus transmissions have slowed down in Bataan, Aklan, and Agusan del Sur, according to the Zuellig Family Foundation (ZFF), which has been helping those three provinces establish their own COVID-19 response system.

In a statement issued on Monday, ZFF attributed the decline in those provinces to “an integrated COVID-19 response with increased testing capacity, enhanced hospital and isolation facilities, and improved contact tracing.”

According to the statement, the effective reproduction number of COVID-19 — or Rt — in the three provinces in the first week of November was below the threshold level, which is set at 1.

The foundation pointed out that the low Rt numbers were not due to a lack of testing.

“The test per capita — or the number of individuals tested for every 100,000 population—has increased by 7% in Bataan, 11% in Aklan, and 19% in Agusan del Sur. Swab test results are released within two days of testing,” ZFF said.

Those provinces also implemented other measures that would limit the spread of the virus.

“With the biggest population among the three provinces and the closest, geographically, to Metro Manila, Bataan has begun using a QR code to monitor the movement of people to and from the province,” ZFF said.

“With these interventions, the case fatality rate (CFR) — or the proportion of deaths among infected patients — in Agusan del Sur and Bataan are kept below the global average (2.8%). Bataan’s CFR is at 1.9% and Agusan del Sur’s is at 1.6%. Aklan is still striving to bring down its 5.2% CFR,” it added.

Recent data from the Department of Health (DOH) show that COVID-19 cases nationwide have started to dwindle, with the lowest number of active cases being recorded in the last three months.

A lot of observers warned, however, that this may just be brought by the recent calamities — typhoons that forced some testing sites to temporarily suspend operations.

Aside from that, DOH itself warned that crowding in evacuation centers — which were set up in schools with the recent onslaught of three typhoons Quinta, Rolly, and Ulysses — may trigger an increase in COVID-19 cases in affected areas.

To date, the country has a total of 409,574 COVID-19 patients — of whom 27,369 are considered active cases while 374,336 have recovered. The death toll stands at 7,839.

Local government play a key role in fighting the pandemic, according to the ZFF chair and president, Ernesto Garilao.

“The success of the COVID-19 response depends on the capacity of the local government units (LGUs) to identify, contact trace and test and provide quarantine facilities for the COVID-19 positives, as well as hospital care for severe cases,” Garilao said.

“Without an integrated COVID-19 responsive system, the virus will make its way to the non-infected,” he added.

Still, he believes there is more to do to ensure that the battle against the pandemic will be won.

“Investments in the local health system must be sufficient to have the following: adequate health manpower for the population, sufficient resources for the different health services, a reliable health information system, adequate medicine supply, adequate financing,” Garilao said.

“Total investments will be high but that is the price to pay for resiliency,” he added.

(This story was published in Inquirer.net on Nov. 17, 2020)